The human hand possesses five metacarpal bones. These bones are the long, thin shafts that are located between the finger phalanges and the carpal bones found in the wrist. When metacarpal fracture happens, it means that one of the five bones in the hand is injured. Metacarpal injuries can be classified according to the bones affected such as the shaft, base, head, and neck fractures. Hospital emergency admissions due to metacarpal injuries only account for 10% of all fracture cases.

This type of injury is very common in people who belong to the working class and adolescents who are on an active lifestyle and constantly use their arms and hands in doing their activities.

Types

• A metacarpal thumb fracture is considered as the rarest among metacarpal injuries because the bone on the thumb can become immobilized, but not necessarily dislocated.
• Rolando’s fracture is the type of metacarpal fracture that is intra-articular. Meaning, it is not only the bones that are affected but the neighboring arteries as well. In this type of fracture, the base of the first metacarpal bone is crushed and fragmenting it to small pieces.

Diagnosis

For the diagnosis, the doctor will ask the patient to undergo a series of brief physical examinations to study the extent of the damage. The hand will be felt for possible tenderness and swelling and the patient will also be required to grip certain objects to test hand strength.

Decreased gripping without almost power strength signifies possible metacarpal injuries. Afterwards, a neurovascular examination of the fingers, hand, and arm will be performed. As for the tests, certain range motion tests may be requested by the doctor. X-rays of the three views of the hand, namely the anteroposterior, oblique, and lateral views are also needed in order for the doctor to assess the angles of the fractured metacarpal fragments as well as the health of the surfaces of the joints. CT scans can also be requested in order to properly check the metacarpal-carpal joints. CT scans are specifically requested when the case of metacarpal injury is severe.

Metacarpal Fracture Causes

Most metacarpal cases are the cause of trauma such as injuries from accidents. The usual types of patients are those who participate in sports like boxing and football. Individuals who constantly do activities wherein the hands are always used but are not protected are also at high risk of having metacarpal fractures. Other cases are the result of having joint or bone diseases such as osteoporosis or bone cancer. People with nutritional and vitamin deficiencies, especially calcium deficiency, are also prone to metacarpal fractures.

Metacarpal Fracture Symptoms

• Tenderness and Swelling
• Trouble in moving the finger
• Deformed or shortened fingers
• Depressed bones in knuckles
• Finger crossing to the next finger when the hand is tried to ball into a fist

Metacarpal Fracture Treatment

There are two types of treatment for metacarpal fractures. The first one is the non-surgical treatment which involves the physician realigning the fractured bones with the use of fracture-braces, splints, or casts. The fracture-brace is a tool that holds the hand firmly in place in order to immobilize the bones in their proper places until they heal. Casts, on the other hand, are also like fracture-braces except that they cover the fingertips up to the elbow.

Non-surgical treatments like these will require the patient to wear the casts for four to six weeks. After three weeks of wearing the casts, the doctor may require the patient to undergo gentle hand exercises to keep the blood flow constant and normal.

The next type of treatment may require surgery. Only metacarpal fractures that have caused breaks on the skin and overly crushed bones are the ones that need surgical methods. In the actual surgery, an orthopedic surgeon will implant the plates, screws, or wires on the broken fragment to keep the bones together. One advantage of using surgical methods is that the patient is assured his bones will become realigned again. Studies have also proven that internal fixing of the fragments give faster healing results especially if aided with physical therapy. For rare severe cases of fracture that causes damage to multiple metacarpal bones, the use of an external metal tool that will hold the fragments together while letting the patient move his joints may be necessary.

Prevention

People who should be careful against metacarpal fractures are athletes such as boxers and those who constantly use their hands on their jobs. Before training or working out, make sure that the hand is properly covered and protected by gloves to limit the force that will be subjected to the hand.

When to Call a Doctor

Most metacarpal fractures are not serious and are very easy to treat. Swelling and dislocation of bones mean that the bones are probably fragmented inside the hand and it can lead to infection if not given proper medical attention.